Thank you for taking the time to fill out this questionnaire. Your
answers will allow us to work more efficiently and economically on your behalf.
PROPOSED TRADEMARK*: _______________________________________________________________
*If available, please attach an exact copy of the proposed mark,
including all associated elements and slogans.
1. Full legal name of the owner
of the proposed mark.
a corporation or LLC, indicate correct legal name and state of formation. (if
originally used by a predecessor organization, state its name and relationship).
an individual, are you a citizen of the United States?
2. Address of principal place
of business; and official address in state of incorporation, if different.
3. Please provide you telephone,
fax, e-mail and URL information:
4. Name and title of individual
who will sign the Trademark Application:
provide a detailed description of the nature of the business with which the
mark will be used.
6. Countries where you currently
7. Is owner an (check one)
___ an individual.
___ a partnership.
___ a corporation.
___ a limited liability company.
___ other (please explain)
8. (a) Has
the mark been used commercially in the United States in connection with either
the sale of goods or services?
your answer is “No,” please provide details of the anticipated timeline for
use of the mark.
specific dates of all publications (printed or online), sales, offers for sale,
and public display and/or use of goods or services bearing the trademark, whether
by you or by any other individual or entity, whether in the US or any foreign
country. If copies of such materials
are available, please provide copies.
goods and/or services are intended to be offered in connection with this trademark?
you secured a domain name using the proposed mark, or, perhaps, a portion of
the proposed mark? If so, please
list the domain name(s) below:
provide the date of first commercial shipment across state lines of the goods
or service bearing the trademark. Please state whether you have evidence
of this date, and what that evidence is. If
the mark is associated with different goods or services, please provide dates
relevant to type of use with each separate or specific good or service.
provide examples (specimens) of the manner in which the trademark mark is or
will be applied to products, goods, or services offered and/ or sold under
the mark. Suitable specimens include labels, tags, promotional
materials, brochures or packaging materials used in connection with the goods
11. Will the mark appear in
logo or design form? If so, please
email us a high quality black and white JPEG or hard copy of the logo or design.
12. Will any other marks, slogans,
designs or distinctive packaging be used with the mark? If
so, please describe in detail.
13. Please attach any actual
or proposed advertisements, brochures, handbills, or packaging design.
14. Are there any plans to
use the mark outside the U.S. If
so, when? For what goods or services?
15. Have you ever conducted
a professional trademark search to determine the availability of the mark? If
yes, please attach a copy of the trademark search report.
16. Will the trademark
be assigned to any other entity or individual? If
so, please explain.
Please let us know
whether you have signed any document or agreement that in any way restricts
your use or ownership of the trademark, including, in the case of book
authors, any publishing contract.
18. Please let us know
if there is anything else that might be relevant.
19. JPEGs or
photographs of labeled goods showing the trademark as actually used on the
product are also acceptable, as are containers bearing the trademark. For
internet services, screen shots, or print-outs, showing the mark as displayed
are acceptable. If you are registering
goods in more than one class, or category, there must be specimens for each
Thank you again for taking the time to complete this questionnaire. We
look forward to going over it with you.